Adrenaline rush

Yesterday I took the test to become certified in neonatal resuscitation protocol (NRP). Today I found out that I passed (actually made a 100% on the written half). Ha ... turns out that I didn't need a test to tell me that!

Like I mentioned in a previous entry, this month I'm on call every 4th day to deliveries where something is expected to go wrong in a small way that one person can handle. I always have the full resuscitation team to call with the push of a button (which I did twice yesterday), but it's still just me in charge til they get there, and it's up to me to keep these 90-seconds old babies alive. When I arrived to work yesterday morning, I'd never had to intubate a baby before; when the babies are born with meconium (aka "baby's first poop") in their amniotic fluid and are either not breathing or are giving a very poor respiratory effort, we stick breathing tubes down their tracheas to suction out their meconium. Yes, that is very gross, and I'll even admit it as a doctor that I hate seeing babies covered with mec. Some of these kids are just NASTY at birth! In all of the deliveries that I'd gone to for the last 2 calls, the OB team had called me with enough time to get to the room, set up all my equipment, and grab a warm blanket to whisk the baby off to the warmer as soon as the OB cut the cord. All of my babies had done fine with simple suctioning, and I started to joke again about my white cloud that follows me around on call.

Yesterday I didn't have the same luck. Early in the day I arrived to one of the rooms as the baby's head was being delivered, and I didn't even have time to set up my full equipment. The OB brought the baby to the warmer where I was still hooking up the suctioning, and the baby looked horrible! Limp, blue, no cry ... I paused for 1 second, and then my training kicked in.

I quickly suctioned what I could out of the mouth and grabbed my laryngoscope. Where were the vocal cords? (Despite what TV shows like ER may depict, intubation is not always easy -- especially when your baby has a mouth full of nasty.) I thought to myself, "Ok, pull out and try again ... hurry, hurry ... steady ... there they are! Go! I'm in ... no mec below the cords. Okay, laryngoscope out and reassess. Baby not breathing ... let's bag him. Squeeze-two-three, squeeze-two-three, squeeze-two-three ... Keep it up. C'mon, baby, gimme a cry ... still bagging with no response. Okay, let's do it -- hit the Resus button and call the team. Where are they?? Has it really only been 30 seconds? Wait, what is this? A cry? C'mon, baby ... YES!! Good cry!!! You're pinking up!!"

By the time the team made it upstairs, the baby looked great. I felt a little silly to have them there for a pink, screaming baby, but it was better to have them there and have fixed the problem before their arrival than to have waited too long to call them. My heart was pounding the entire time especially since I was the only one in the room who was in charge of this baby. God really brought everything I studied into my mind at this point!

Later in the night (or actually early this morning), I got called to one of the delivery rooms for what must have been at least the 15th delivery I attended in 24 hours. I announced "Pedi!" as I always do when I entered the room and asked for the story. Initially I was told that mom just had an infection ... no other problems. Okay, that's cool; I'm trained to do that alone. I asked if there was mec(onium) and answered that there was not. As I rushed to set up my equipment, I heard someone at the mom's bedside call out, "She's moderate mec." Oh really now? Hmm, I can handle 2 things alone, but I better check and make sure the 3rd element of the so-called "triple threat" wasn't there. "How is the baby's heartrate?" "Actually, since you asked, he's been decelling with every contraction." CRAP. Infection + meconium (a sign of potential fetal distress) + abnormal fetal heart tones = triple threat = resus team = why the heck did they call just the intern??? They should have known better. I radioed my senior resident on call on the walkie we carry to confirm that I shouldn't be there alone, and I was instructed to push the Resus button NOW.

In the meantime (of course), the baby was delivered. It was COVERED in grossness and not breathing. Being the only pediatric provider in the room at this time, I grabbed my equipment and prepped for intubation. This one was harder; I was scared and had a hard time visualizing what I was supposed to see, but I KNEW it had to be done. Praise God, I got the intubation on the first try. Unfortunately this baby did have meconium below the cords and didn't respond at all at first to my efforts. By this time, the team had arrived and took over resuscitation. It was a good thing they were there because this kid needed way more support than I could provide or even than the senior could have provided alone. He ended up doing fine, but it was SCARY!

My whole point is that my life feels like one big test sometimes. I don't study anymore to make a good grade. I study because my patients depend on my knowledge; sometimes they even stake their lives on it. I'm glad I passed when it counts.